title: Mini-loop ligation of a bleeding duodenal Dieulafoy's lesion.
abstract: Two percent of gastrointestinal hemorrhages are caused by Dieulafoy's lesions, which are located in duodenum in only 15% of cases. There are no recommendations regarding the prime endoscopic treatment technique for this condition. A 61-year-old woman presented with melena without signs of hemodynamic instability. During an urgent upper endoscopy, blood oozing from the normal mucosa of the duodenum was seen and this was classified as a Dieulafoy's lesion. A mini-loop was opened at the rim of a transparent ligation chamber, at the end of the endoscope, and after aspiration of the lesion, closed and detached. Complete hemostasis was achieved without early or postponed complications. In every day clinical practice, mini-loop ligation is rarely used because of possible complications, such as site ulceration, organ perforation, re-bleeding and possible inexperience of the operator. To the best of our knowledge this is the first case of successful treatment of bleeding duodenal Dieulafoy's lesion by mini-loop ligation.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical and Dental Faculty, "Sestre Milosrdnice" University Hospital Center, University of Zagreb, 10000 Zagreb, Croatia. marijagomercic@yahoo.com
authors.forename: Marija
authors.initials: M
authors.lastname: Gomerčić Palčić
authors.forename: Neven
authors.initials: N
authors.lastname: Ljubičić
mesh_terms: D004384:Duodenoscopy; D004386:Duodenum / Q000098:blood supply* / Q000601:surgery*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D016558:Hemostasis, Endoscopic; D006801:Humans; D007413:Intestinal Mucosa / Q000098:blood supply* / Q000601:surgery*; D008026:Ligation; D008551:Melena / Q000209:etiology; D008875:Middle Aged; D016896:Treatment Outcome; D054079:Vascular Malformations / Q000150:complications / Q000175:diagnosis / Q000601:surgery*
keywords: Dieulafoy’s lesion; Duodenum; Endoscopy; Hemostasis; Mini-loop